QEF NeuroRehabilitationServices

©QEF NRS October 2015

Service Provision

achievinggoals for lifeqef.org.uk

Tumour

Infection

Stroke

Metabolic Disorder

Hypoxia

Anoxia

Hydrocephalus

TBI

QEF Neuro Rehabilitation Services (QEF NRS) hasprovided specialist Acquired Brain Injury (ABI)services at its Surrey-based centre for more than 20years.

The level of specialist consultant-ledneurorehabilitation delivered at NRS is that of a 2bunit according to national standards.

QEF NRS provides comprehensive neurorehabilitationfor male and female clients aged 16-65 years whohave moderate to severe physical, cognitive and/orcommunicative disabilities which may include mildto moderate behavioural problems.

Programmes are residential or non-residential andinclude intensive neurorehabilitation, vocationalrehabilitation, transition support and outreachservices.

QEF NRS client gender

The ABI may be the result of trauma, stroke, tumour,anoxia, meningitis or a neurological condition.Clinical evidence supports the early access tospecialist neurorehabilitation services for clients withan ABI. Clients who have had an early referralprogramme in the acute stages of recovery havesignificantly better social integration, emotional well-being and vocational functioning than thoseindividuals receiving rehabilitation services later inrecovery, despite having greater functional limitations upon entry1. The effectiveness has beendemonstrated of early intensive rehabilitation withspecialist programmes for those with complex needsand specialist vocational programmes for those withthe potential to return to work2.

Causes of Acquired Brain Injuryreferals to QEF NRS (2012-2014)

Location

QEF NRS is located in Banstead, Surrey, a short walkfrom the local village with full amenities; it is aspacious, well-equipped building in six acres ofgardens, woodland and recreation areas. Clientshave their own bedroom equipped with aids and acall system; they may move, when appropriate, toindependent living units, a group home orindependent living flats all on the same site, tofacilitate increasing independence.

Interdisciplinary team

QEF NRS has a specialist and highly experiencedinterdisciplinary team (see Table 1).

Table 1: QEF NRS interdisciplinary team

• Consultant in rehabilitation medicine/medicaldirector

• Nursing and rehabilitation support team • Physiotherapists• Speech and language therapists• Occupational therapists• Neuropsychologists• Vocational team• Art and design technology tutors• Recreation team

2%2%1%2%

6%

19%

6%

62%

Male

Female

15%

85%

Residential and non-residentialrehabilitation services

QEF NRS provides a wide range of residential andnon-residential specialist rehabilitation services (seeTable 2).

Table 2: Range of services provided by QEF NRS

• Physiotherapy• Speech and language therapy• Occupational therapy • Neuropsychology • Vocational rehabilitation including workplacements and re-entry to work

• Transition• Medico-legal assessment includingcapacity and neuropsychologicalassessments

• Outreach: community rehabilitation andsupport (home or centre-based)

• Advisory and counselling service

QEF NRS has a client-centred approach; aprogramme is developed for each client and tailoredto suit their individual needs and goals. Clients attend1:1 or group sessions and the programmes are ofvarying duration, depending on the severity ofdisability and individual needs. Many clients at QEFNRS require a minimum three to six monthsrehabilitation programme; others may requirebetween 12 and 24 months. A review by Turner-Stokes et al (2011) showed that more intensiverehabilitation is associated with rapid functionalgains once the patient is fit to engage. Highlydependent patients with severe traumatic brain injuryalso made sufficient functional gains, but requiredlonger lengths of stay and more intensive treatment3.

Duration of rehabilitation programme forclients discharged from QEF NRS since 2012

1-3 months

3.1-6 months

6.1-9 months

9.1-12 months

12.1-18 months

18.1-24 months14%

16%

39%

22% 14%

5%

Tumour

Infection

Stroke

Metabolic Disorder

Hypoxia

Anoxia

Hydrocephalus

TBI

Admission criteria

QEF NRS admits clients from 16 years of age with ABIwho are medically stable (see Table 3). The Centrehas a specific expertise with young people between16 and 24 years; to date 63% of clients admittedhave been within this age group. Clients must havethe potential to benefit from, and the ability toparticipate in, rehabilitation programmes.

Table 3: QEF NRS admission criteria

• Males and females with Acquired BrainInjury

• From 16 years of age • Medically stable • Potential to benefit from, and the ability toparticipate in rehabilitation programmes

Clients may have a range of problems includingphysical, cognitive, communication, psychological,behavioural and social, all requiring rehabilitationfrom an expert interdisciplinary team (see Table 4).

Table 4: Range of problems managed by QEF NRS

• Physical • Medical (e.g PEGs, catheters, VP shunts,epilepsy, diabetes)

• Cognitive• Communication• Psychological• Behavioural• Social

Referrals come from medical, social care, legal andpersonal injury professionals. Clients may be referredfrom hospital to begin their programme at QEF NRS.Some clients are referred several years after theirinjury, from home, when it becomes apparent thatthey are not fulfilling their potential for completing thetasks of daily living, or from a vocational perspective.

Residence prior to admission to QEF NRS

Time to access QEF NRS from assessment toadmission 2012-2014

0-3 months

3.1-6 months

6.1-9 months

8%

6%

86%

Acute neurorehabilitation

Living with family

Living alone with support

Residential care

24%

6%3% 67%

Assessment

The client, their family and the commissioner orfunding representative are invited for an informal visitto QEF NRS, as appropriate. A preliminary assessmentis carried out to identify rehabilitation needs, goalsand the client’s potential. An evaluation report isproduced together with the recommendedrehabilitation programme and cost.

Admission

On admission, the client has a full baselineassessment, Goal Attainment Scaling (GAS) goals areagreed and a rehabilitation programme developedaccording to the individual’s needs. Aninterdisciplinary team is then assigned to the client.

The client is assessed using the FunctionalIndependence Measure (FIM) to evaluate functionalstatus throughout the rehabilitation process. They arealso assessed using the Functional AssessmentMeasure (FAM) that specifically addresses the majorfunctional areas that are emphasised less in FIM suchas cognitive, behavioural and communicationdifficulties.

Monitoring and outcomes

Progress towards the GAS goals is reviewed fortnightlyand data submitted to the UK Rehabilitation OutcomesCollaborative (UKROC) database. Three-monthly (ormore frequently if required) progress reports areprepared.

Weekly key worker review meetings take place withthe client and a weekly interdisciplinary team caseconference is also held. The key workers, therapistsand nurses are in regular communication with thefamily.

A study of 106 adults aged 16-36 years with moderateto severe traumatic brain injury who attended andwere discharged from QEF NRS over a period of 10years found that they made clinically and statisticallysignificant improvements in their functional abilitiesduring their neurorehabilitation4. This improvementwas predicted by their initial functional ability andalso the duration of their QEF NRS rehabilitationprogramme.

Functional independence at admission anddischarge (measured by FIM/FAM) at QEF NRS

Cognitivedependencyat admission

Cognitivedependencyat discharge

Motordependencyat admission

Motordependencyat discharge

32%31%

37%

5%

42%

53% 32%

21%

47%

16%

26%

58%

High

Medium

Low

Acute neurorehabilitation

Living with family

Living alone with support

Residential care

Transition and discharge

As part of their rehabilitation programme, QEF NRShelps the client decide where they would like to live,daytime activities they would like to undertake whenthey are discharged, and support required if the clientgoes on to college or university. A final report on theclient’s support needs is prepared and circulated tothe relevant professionals and relatives. Transitionplanning is a key part of the discharge process andtraining is provided for support workers to enable asmooth onward journey.

From 2012 to 2014, 23% of clients leaving QEF NRSwere able to live independently, 51% were able toreturn home to live with either their parents or apartner and 18% could live independently withsupport.

Destination of QEF NRS clients (2012-2014)

QEF NRS has an excellent track record for returningclients to the education system. From 2012 to 2014,19% of clients leaving QEF NRS were in full-timeeducation and 12% were in part-time education(school, college or university). In addition 6% were inpaid employment, 12% in voluntary employment and18% were attending employment retraining.

Educational/vocational progress of clientsleaving QEF NRS (2012-2014)

References

1 Reid-Arndt SA., Schopp L, Brenneke L et al. Evaluation ofthe traumatic brain injury early referral programme inMissouri. Brain Injury 2007;21(12):1295-1302.

2 Turner-Stokes L. Evidence for the effectiveness of multi-disciplinary rehabilitation following acquired brain injury: Asynthesis of two systematic approaches. Journal ofRehabilitation Medicine 2008;40(9):691-701.

3 Turner-Stokes L, Nair A, Sedki I et al. Multi-disciplinaryrehabilitation for acquired brain injury in adults of workingage (Review). 2011. The Cochrane Library 1.

4 Foy CML and Somers JS. Increase in functional abilitiesfollowing a residential educational and neurorehabilitationprogramme in young adults with acquired brain injury.Neurorehabilitation 2013;32:671-678.

For further information on referrals, please contact:

Placements ManagerQEF Neuro Rehabilitation ServicesBanstead Place, Park Road, Banstead, Surrey SM7 3EE

T: 01737 356222E: neurorehab@qef.org.uk

Independent

Supported living

Residential care

Rehab

Living with Family

Partner

30%

25%10%

10%

5%

20%

Paid employment

Voluntary employment

Full-time education

Part-time education

Supported weekly activities

Re-training

Rehab Centre

31%

12%

6%18%

18%

12%2%

Admission criteria• Males and females with acquired brain injury • From 16 years of age (speciality for younger adults) • Medically stable • Potential to benefit from, and the ability to participate in QEF NRS programmes

Referral from medical, social care, legal and personal injury professionals

Informal visit to QEF NRS from client, family and funding representative

Preliminary assessment• Discuss rehabilitation needs • Determine goals • Assess client potential • Produce evaluation report including proposed rehabilitation strategy and cost

Client offered a place at QEF NRS and funding secured

Client arrives at QEF NRS and rehabilitation journey commences

On admission • Interdisciplinary team assigned• Programme agreed• Full baseline assessment• GAS goals agreed• Evaluation of client status using UKROC outcome tools

Monitoring and outcomes • Progress towards GAS goals is reviewed fortnightly and data submitted to UKROC • Weekly key worker review meetings• Weekly interdisciplinary team case conference • UKROC outcome measures used to evaluate rehabilitation process• Three-monthly progress reports prepared (or more frequently as required) • Programme adapted as required• Key workers/therapists/nurses in regular communication with family

Transition and discharge • Assistance with identifying accommodation and daytime activities that theclient would like to undertake

• Referrals are made to the community team as required • Training for support workers to ensure smooth transition• Support provided for clients who go on to college/university

QEF Neuro Rehabilitation ServicesClient journey

For further information on referrals, please contact:

Placements ManagerQEF Neuro Rehabilitation ServicesBanstead Place, Park Road, Banstead, Surrey SM7 3EE

T: 01737 356222E: neurorehab@qef.org.ukW: www.qef.org.uk © QEF NRS October 2015